Methods of laser modification of intraocular lens

ABSTRACT

A method of modifying a refractive profile of an eye having an intraocular device implanted therein, wherein the method includes determining a corrected refractive profile for the eye based on an initial refractive profile, identifying one or more locations within the intraocular device based on the corrected refractive profile, and directing a pulsed laser beam at the locations to produce the corrected refractive profile. A system of modifying an intraocular device located within an eye, wherein the system includes a laser assembly and a controller coupled thereto. The laser assembly outputs a pulsed laser beam having a pulse width between 300 picoseconds and 10 femtoseconds. The controller directs the laser assembly to output the pulsed laser beam into the intraocular device. One or more slip zones are formed within the intraocular device in response thereto, and the slip zones are configured to modify a refractive profile of the intraocular device.

RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 12/239,462, filed Sep. 26, 2008, the entire content of which isincorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates generally to intraocular lenses and moreparticularly, to systems and methods for modifying in-situ intraocularlenses.

BACKGROUND

When the natural lens of the eye becomes cataractous, the natural lensmay be replaced with an intraocular lens. The natural lens may also bereplaced with an intraocular lens to correct other visual conditions,for example, to provide accommodation or pseudo-accommodation whenpresbyopia develops, which limits the focus capability of the eye onboth distant objects and near objects. Accommodating and/or multifocalintraocular lenses may be used to restore at least some degree ofaccommodative or pseudo-accommodative ability. In general, accommodatingintraocular lenses are configured to provide focus on objects over arange of distances (e.g., by axial displacement and/or by shape changein response to ocular forces, such as those produced by the ciliarymuscle, zonules, and/or the capsular bag of the eye).

At times, the position of the intraocular lens within the eye may changeafter the insertion procedure has been completed. Additionally,inaccurate, pre-operative eye measurements (e.g., used to select theintraocular lens properties or position the same within the eye) mayrequire changes to the position or effective refractive properties ofthe intraocular lens. U.S. Pat. No. 5,571,177 describes an intraocularlens having a fixation member with an alterable portion structured to bealtered after the intraocular lens is placed in the eye. For example, aNd:YAG laser is described in U.S. Pat. No. 5,571,177 for producing alaser beam to break the alterable portion of the fixation member. TheNd:YAG crystal associated with this laser can typically generate a laserbeam with a pulse width no shorter than about 10 picoseconds, whichlimits the type, degree, and precision of structure alteration.

It is desirable to provide improved methods and systems of modifying theposition of in-situ intraocular devices (e.g., intraocular lensespositioned within the eye). It is also desirable to provide methods andsystems for modifying the refractive profile of the eye via modificationof in-situ intraocular devices. The term “refractive profile” is usedherein to generally describe the optical properties associated with aneye, which may be determined by a variety of techniques including, byway of example and not limitation, wavefront determination Inparticular, it is desirable to provide an ophthalmic surgical system anda method of ophthalmic surgery for re-positioning an in-situ intraocularlens via precision alteration of one or more support elements. It isalso desirable to provide an ophthalmic surgical system and a method ofophthalmic surgery for assembling separately implanted components of anin-situ intraocular device. Additionally, other desirable features andcharacteristics of the present invention will become apparent from thesubsequent detailed description and the appended claims, taken inconjunction with the accompanying drawings and the foregoing technicalfield and background.

SUMMARY OF THE INVENTION

The present invention is generally directed to ophthalmic devices,systems, and methods for modification of an in-situ intraocular device(e.g., an intraocular lens) using a laser system that may be directedthrough ocular anatomy to photoalter the intraocular device at a desiredfocal point. Laser energy may be directed into one or more portions ofthe intraocular device (e.g., at a support element or an optic of theintraocular lens) to modify the intraocular device. One advantage isthat the intraocular lens may be altered, positionally adjusted tofine-tune a desired refractive correction, or the like, after theintraocular lens has been inserted or implanted. Refractive propertiesassociated with the cornea may also be taken into account when alteringthe intraocular lens or while positionally adjusting the intraocularlens. For example, real-time refractive analysis (e.g., provided by awavefront aberrometer, a topographer, or the like) of one or morecomponents of the eye may be concurrently used during positioning tocorrelate the position of the intraocular lens with the desiredrefractive correction.

In one embodiment, a system for modifying an intraocular device locatedwithin an eye is provided. The system includes a laser assembly and acontroller coupled to the laser assembly. The laser assembly isconfigured to output a pulsed laser beam having a pulse width betweenabout 300 picoseconds and about 10 femtoseconds. The controller isconfigured to direct the laser assembly to output the pulsed laser beaminto the intraocular device. The pulsed laser beam forms one or moreslip zones within the intraocular device, and the slip zone(s) areconfigured to alter a refractive property associated with theintraocular device.

In another embodiment, a method of modifying a refractive profileassociated with an eye having an intraocular device implanted therein isprovided. The method includes determining a corrected refractive profilebased on an initial refractive profile of the eye, identifying one ormore locations within the intraocular device based on the correctedrefractive profile, directing a pulsed laser beam at the one or morelocations to produce the corrected refractive profile.

In another embodiment, a system is provided for modifying an intraoculardevice having a surface region and one or more subsurface regions. Thesystem includes a laser assembly configured to output a pulsed laserbeam and a processing unit coupled to the laser assembly. The processingunit is configured to control the laser assembly to direct the pulsedlaser beam at one or more subsurface regions of the intraocular device.The one or more subsurface regions being structurally altered inresponse to the pulsed laser beam while maintaining a mechanicalproperty of the surface region.

In another embodiment, a method is provided for modifying a refractiveprofile associated with an eye via an intraocular device. The methodincludes implanting an optic of the intraocular device within the eye,implanting a support element of the intraocular device within the eye,and directing a pulsed laser beam into both of the support element andthe optic to fuse the support element to the optic. The intraoculardevice within the eye configured to modify the refractive profile.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, wherein like reference numerals refer to similarcomponents:

FIG. 1 is a block diagram of a system for modifying an in-situintraocular device in accordance with one embodiment of the presentinvention;

FIG. 2 is a block diagram of an ophthalmic laser system in accordancewith one embodiment;

FIG. 3 is a schematic drawing of the human eye with the implantedintraocular lens shown in FIG. 1;

FIG. 4 is a top sectional view of an implanted intraocular lensillustrating a re-orientation in accordance with one embodiment;

FIG. 5 is a top sectional view of the implanted intraocular lensillustrating a re-orientation in accordance with another embodiment;

FIG. 6 is a side sectional view of the implanted intraocular lensillustrating a re-orientation in accordance with another embodiment;

FIG. 7 is a sectional view of an intraocular lens illustrating slipzones in accordance with one embodiment;

FIG. 8 is a front view of a display illustrating an intraocular lensmodification in accordance with one embodiment;

FIG. 9 is a flow diagram of a method for modifying a refractive profileof an eye having an intraocular lens implanted therein in accordancewith one embodiment; and

FIG. 10 is a flow diagram of a method modifying a refractive profileassociated with an eye having an intraocular lens implanted therein inaccordance with another embodiment.

DETAILED DESCRIPTION

The present invention generally provides systems and methods formodifying an intraocular lens, particularly an in-situ (e.g., positionedwithin an eye) intraocular lens, although these systems and methods canalso modify intraocular lenses prior to implant or insertion. Thesystems and methods are utilized to structurally modify one or moresubsurface regions within the intraocular lens while maintaining themechanical or structural nature (i.e., prior to this modification) ofthe surface region of the intraocular lens. In one embodiment,subsurface regions of one or more support elements (e.g., a haptic orother support element coupled to the optic of the intraocular lens) ofthe in-situ intraocular lens are modified to adjust the position of theintraocular lens within the eye. Laser energy (e.g., supplied by a lasersystem outputting a pulsed laser beam having a pulse width within afemtosecond range) is used to irradiate the desired subsurface regionsof the in situ intraocular lens. In another embodiment, laser energy mayalso be used to irradiate subsurface regions within the optic to alterthe mechanical properties of the optic (e.g., to increaseviscoelasticity, create a plastic effect, or the like).

With these systems and methods, the mechanical or structural propertiesof the optic and/or haptic (or other support element) associated withthe in situ intraocular lens may also be advantageously modified in anon-intrusive or minimally intrusive manner. In one embodiment, thepulsed laser beam forms one or more slip zones in the intraocular lens.The term “slip zone” is defined herein to be a region of material (e.g.,in the optic or support element) configured to have one portion capableof translational displacement with respect to an adjacent portion, suchas in response to certain movements of the capsular bag containing theintraocular lens after implantation/insertion. As a result, the positionof the intraocular lens within the eye may be finely adjusted in one ormore directions (e.g., anteriorly, posteriorly, rotationally,vertically, horizontally, tilted, combinations of one or more of theforegoing, and the like). For example, the intraocular lens may bere-oriented such that the anterior surface of the optic abuts theanterior portion of the capsular bag. A variety of re-orientations of anin situ intraocular lens are thus possible. Additionally, the formationof one or more slip zones in the optic can be used to facilitate somedegree of accommodation capability of the intraocular lens or enhanceaccommodation capability that has been pre-engineered in the intraocularlens.

The systems and methods of the present invention are well suited forcustomizing (e.g., fitting or adjusting) intraocular lenses to aparticular recipient. For example, as a result of modifying one or moresubsurface regions of the intraocular lens (e.g., a haptic), theintraocular lens may be horizontally displaced, vertically displaced,displaced towards the cornea, displaced towards the retina, rotated,tilted, and the like, or any combination thereof.

While used to modify in-situ intraocular lenses, the systems and methodsof the present invention may also be used to modify intraocular lensesprior to implantation (e.g., modify a haptic or structure coupling thehaptic to the optic or join and fix the haptic to the optic), such asduring manufacture of the intraocular lens, customization of theintraocular lens biomechanics to implement a refractive correction for aparticular recipient, pre-implantation/insertion assembly, and the like.Additionally, other intraocular devices replacing the natural lens inthe eye can be modified by these systems and methods.

In one embodiment, a laser assembly outputting a non-ultraviolet (UV),ultrashort pulsed laser beam (e.g., having a pulse duration or pulsewidth as long as a few picoseconds or as short as a few femtoseconds) isused to provide the laser energy for subsurface modifications of thein-situ intraocular lens. This pulsed laser beam has a wavelengthpermitting passage of the pulsed laser beam through the cornea and othertissue or fluids between the intraocular lens and the outer surface ofthe cornea while minimizing or preventing energy absorption by suchtissue or fluids except at the focal point of the pulsed laser beam. Thelaser assembly can be used to perform post-implant procedure adjustmentsto the intraocular lens or assembly thereof following a recovery period(e.g., for the eye to recover from the procedure). During this recoveryperiod, the intraocular lens may settle to a more permanent positionwithin the eye. The laser assembly may also be used during the implantprocedure to modify the support element(s) of the intraocular lens froma state that is more favorable for insertion through an inserter to astate that is better suited for operation of the intraocular lens withinthe eye. By modifying a subsurface region of the intraocular lens, theintraocular lens is re-oriented or modified while minimizing potentialleaching or particulate production.

Referring to the drawings, a system 10 for modifying an in-situintraocular lens 30 is shown in FIG. 1 in accordance with oneembodiment. The system 10 is suitable for ophthalmic applications andmay be used to photoalter a variety of materials (e.g., organic,inorganic, or a combination thereof). In one embodiment, the system 10includes, but is not necessarily limited to, a laser 14 capable ofgenerating a pulsed laser beam 18, an energy control module 16 forvarying the pulse energy of the pulsed laser beam 18, a scanner 20(e.g., a micro-optics scanning system), a controller 22, a userinterface 32, an imaging system 34, and focusing optics 28 for directingthe pulsed laser beam 18 from the laser 14 into the eye 12. Thecontroller 22 communicates with the scanner 20 and/or focusing optics 28to direct the focal point of the pulsed laser beam 18. Software (e.g.,instrument software, and the like), firmware, or the like, can beexecuted by the controller 22 to command the actions and placement ofthe scanner 20 via a motion control system, such as a closed-loopproportional integral derivative (PID) control system. In thisembodiment, the system 10 further includes a beam splitter 26 and adetector 24 coupled to the controller 22 to provide a feedback controlmechanism for the pulsed laser beam 18. The beam splitter 26 anddetector 24 may be omitted in other embodiments, for example, withdifferent control mechanisms. To modify the in situ intraocular lens 30,the controller communicates with the scanner 20 and/or focusing optics28 to direct the focal point of the pulsed laser beam 18 into the insitu intraocular lens 30 (i.e., sub-surface).

A variety of intraocular lenses may be implanted and modified in-situ bythe system 10 including, but not necessarily limited to, monofocalintraocular lenses, multifocal intraocular lenses, accommodatingintraocular lenses, and the like. Some intraocular lenses include, byway of example and not of limitation, the ReZoom™ multifocal lens, theVerisyse™ phakic lens, and the Tecnis® aspheric lens manufactured byAdvanced Medical Optics, Inc., the AcrySof® ReStor®, AcrySof® IQ, andAcrySof Tonic intraocular lenses manufactured by Alcon, Inc., and theCrystalens® intraocular lens manufactured by Bausch & Lomb, Inc. Someother examples of intraocular lenses are found in U.S. Pat. No.5,571,177, which discloses intraocular lenses that are specificallystructured to be post-operatively re-positioned. The system 10 modifiesthe intraocular lens 30 via photoalteration of one or more desiredsubsurface regions of the intraocular lens 30. Examples ofphotoalteration include, but are not necessarily limited to, chemicaland physical alterations, chemical and physical breakdown, liquefaction,polymerization, disintegration, ablation, vaporization, or the like.Localized photoalterations can be placed at the targeted portion (i.e.,in the desired subsurface region) of the intraocular lens 30 to providehigh-precision processing. Where the pulsed laser beam 18 is directed(e.g, the focal point of the pulsed laser beam 18), the laser energyassociated with the pulsed laser beam 18 modifies the material of theintraocular lens 30 and/or the mechanical properties associatedtherewith. For example, the mechanical properties associated with aspecific component or portion of the intraocular lens 30 can be modifiedto have increased/decreased rigidity, increased/decreasedviscoelasticity, increased/decreased flexibility, and the like. Inanother example, an intraocular lens with pre-stressed haptics can betreated by the system 10 to form slip zones in the haptics, thereby atleast partially relieving the stress.

Different intraocular lenses or portions of a particular intraocularlens can have a variety of materials, each requiring different amountsof energy to effect a desired modification. For example, the optic andsupport element (e.g., a haptic) may each have different materialcompositions, and the support element may have different materialcompositions within different regions thereof (e.g., a non-homogeneoussupport element). The controller 22 preferably directs the energycontrol module 16, the scanner 20, or a combination of both, to producea pulsed laser beam having sufficient energy to modify the intraocularlens material. For example, the energy control module 16 can vary thepulse energy in response to the controller 22 to produce the pulsedlaser beam 18 with sufficient energy to modify the mechanical propertiesof subsurface regions of the haptic or a hinge or other structurecoupling the haptic to the optic. Thus, the mechanical propertiesassociated with the haptic or optic or both can be modified via thesubsurface modifications to the intraocular lens 30. The spacing betweenadjacent pulses of the pulsed laser beam 18 can be varied, as well asthe pulse repetition rate, spot size, and the like, to providesufficient energy.

In one embodiment, the controller 22 directs the energy control module16, the scanner 20, or a combination of both, to produce the pulsedlaser beam 18 with pre-determined properties (e.g., corresponding with aspecific intraocular lens or material) to modify the intraocular lens30. Based on the physical characteristics of the intraocular lens to beimplanted, the controller 22 selects pre-determined values of pulseenergy, pulse width, pulse repetition rate, spot separation, or thelike, or any combination thereof, to provide the energy for modifyingthe support element. For example, the specific type, brand, model, etc.,of intraocular lens to be implanted may be input via the user interface32. In response to this input information, one or more look-up tablesare accessed by the controller 22 to retrieve the correspondingpre-determined values (e.g., to provide the appropriate energy formodifying the support element of the intraocular lens). For example, theentire intraocular lens or one or more portions of the intraocular lensmay be formed from polymethylmethacrylate (PMMA). In this example, thelook-up table contains an exposure time, a pulse energy value, a scanpattern, or the like, that corresponds with heating the subsurfaceregion(s) above the glass transition temperature (T_(g)) associated withPMMA to modify the support element. By heating pre-determined subsurfaceregions of the support element above T_(g), the support element istemporarily softened thereby allowing the support element to be bent,compressed, or otherwise altered from an original implanted state. Thelook-up tables can contain different pre-determined settings for avariety of materials, intraocular lens type, brand, model, etc.,corresponding with the composition of the intraocular lens 30. Thus, apulsed laser beam having the appropriate characteristics for modifyingthe subsurface regions of the intraocular lens 30 can be automaticallyproduced by the system 10. The properties of the pulsed laser beam 18may also be manually modified from default values (e.g., for acustomized modification) or manually input by the operator as originaloperating values.

To provide the pulsed laser beam 18, the laser 14 utilizes a chirpedpulse laser amplification system in one embodiment,—such as thatdescribed in U.S. Pat. No. RE37,585—, for photoalteration. U.S. Pat.Publication No. 2004/0243111 also describes other methods ofphotoalteration. Other devices or systems may be used to generate pulsedlaser beams, including, by way of example and not limitation, the FSlasers manufactured by IntraLase Corp., the FEMTO LDV™ lasermanufactured by Ziemer Ophthalmic Systems AG, the FEMTEC® laser by 20/10Perfect Vision AG, and the VisuMax® laser manufactured by Carl ZeissMeditec AG. For example, non-ultraviolet (UV), ultrashort pulsed lasertechnology can produce pulsed laser beams having pulse durationsmeasured in femtoseconds. For example, U.S. Pat. No. 5,993,438, theentire disclosure of which is incorporated herein by reference,discloses an intrastromal photodisruption technique for reshaping thecornea using a non-UV, ultrashort (e.g., femtosecond pulse duration),pulsed laser beam that propagates through corneal tissue and is focusedat a point below the surface of the cornea to photodisrupt stromaltissue at the focal point. In the system 10, the pulsed laser beam maybe focused beyond the stromal tissue and into the capsular bag (e.g., tomodify the intraocular lens 30).

The system 10 is capable of generating the pulsed laser beam 18 withphysical characteristics similar to those of the laser beams generatedby a laser system disclosed in U.S. Pat. No. 4,764,930, the entiredisclosure of which is incorporated herein by reference, U.S. Pat. No.5,993,438, or the like. For example, the system 10 can produce a non-UV,ultrashort pulsed laser beam for modifying the support element of theintraocular lens 30. The pulsed laser beam 18 preferably has laserpulses with durations as long as a few picoseconds or as short as a fewfemtoseconds. For intraocular photoalteration, the pulsed laser beam 18has a wavelength that permits the pulsed laser beam 18 to pass throughthe cornea and the anterior chamber without absorption by either or withinsignificant absorption. The wavelength of the pulsed laser beam 18 isgenerally in the range of about 3 μm to about 1.9 nm, preferably betweenabout 400 nm to about 3000 nm, and is more preferably about 1053 nm.

The irradiance of the pulsed laser beam 18 for accomplishingphotoalteration at the focal point is sufficient for the materialassociated with the support element. Although a non-UV, ultrashortpulsed laser beam is described in this embodiment, the laser 14 canproduce a laser beam with other wavelengths in other embodiments. In oneembodiment, the laser 14 preferably has a pulse repetition rate of about150 kHz, although the laser 14 may operate at other pulse repetitionrates (e.g., 30 kHz, 60 kHz, 120 kHz, and the like).

The focusing optics 28 direct the pulsed laser beam 18 toward the eye 12(e.g., through the cornea and on or into the intraocular lens 30) fornon-UV photoalteration of the subsurface regions within the intraocularlens 30. The system 10 may also include an applanation lens (not shown)to flatten the cornea prior to scanning the pulsed laser beam 18 intothe eye 12. A planar, curved, or other shaped lens is used to contactthe cornea.

The user interface 32 provides a flexible and simple environment for theoperator to interact with the system 10. In one embodiment, the userinterface 32 graphically displays (e.g., using a flat panel display orthe like) information, such as from the instrument software controllingthe operation of various components of the system 10, and provides avisual interface between the system 10 and the operator for inputtingcommands and data associated with the various components of the system.A graphical user interface (GUI) is preferably used with the userinterface 32 employing menus, buttons, or other graphicalrepresentations that display a variety of selectable functions to beperformed by the system 10 following selection. For example, theoperator points to an object and selects the object by clicking on theobject, touching a pre-designated region of a touch-screen displayingthe GUI, or the like. Additional items may be presented on the GUI foroperator selection, such as a button or menu item indicating anavailable sub-menu (e.g., a drop-down sub-menu). The user interface 32may also utilize one or more of a variety of input devices including,but not necessarily limited to, a keyboard, a trackball, a mouse, atouch-pad, a touch-sensitive screen, a joystick, a variable focal lengthswitch, a footswitch, and the like.

In addition to the user interface 32, the imaging system 34 displays amagnified real-time digital image of the eye 12 (e.g., a front view) andprovides an interface for viewing the eye 12, including variousstructures thereof, and operator control of the centration or alignmentof the laser output with the eye 12. In one embodiment, an alignment orcentration aid is displayed by the imaging system 34 overlaying thedigital image of the eye 12. The aid corresponds with the position ofthe laser output in reference to the eye 12. As part of thephotoalteration process, the output of the laser 14 is preferablyaligned with the eye 12 (e.g., the center of the pupil, the center ofthe outer boundary of the iris, and the like) and/or the intraocularlens 30. For example, the output of the laser 14 is substantiallycentered with reference to the pupil and iris of the eye 12. In anotherexample, the output of the laser 14 is substantially centered withreference to the optic portion of the intraocular lens 30 (e.g., along acentral optical axis of such optic portion). Viewing the digital imagedisplayed by the imaging system 34, the operator can center the aid(e.g., based on the pupil and/or the iris of the patient's eye and/orthe intraocular lens) and adjust the position of the laser output.

After alignment or centration, the system 10 directs the pulsed laserbeam 18 at the support element of the intraocular lens 30 implanted inthe eye 12. Movement of the focal point of the pulsed laser beam 18 isaccomplished via the scanner 20 in response to the controller 22. Thestep rate at which the focal point is moved is referred to herein as thescan rate. The term “scan” or “scanning” refers to the movement of thefocal point of the pulsed laser beam along a desired path or in adesired pattern. For example, the scanner 20 can operate at scan ratesbetween about 10 kHz and about 400 kHz, or at any other desired scanrate. Further details of laser scanners are generally known in the art,such as described, for example, in U.S. Pat. No. 5,549,632, the entiredisclosure of which is incorporated herein by reference.

In one embodiment, the scanner 20 utilizes a pair of scanning mirrors orother optics (not shown) to angularly deflect and scan the pulsed laserbeam 18. For example, scanning mirrors driven by galvanometers areemployed where each of the mirrors scans the pulsed laser beam 18 alongone of two orthogonal axes. A focusing objective (not shown), whetherone lens or several lenses, images the pulsed laser beam 18 onto a focalplane of the system 10. The focal point of the pulsed laser beam 18 isthus scanned in two dimensions (e.g., the x-axis and the y-axis) withinthe focal plane of the system 10. Scanning along the third dimension,i.e., moving the focal plane along an optical axis (e.g., the z-axis),may be achieved by moving the focusing objective, or one or more lenseswithin the focusing objective, along the optical axis. Any combinationof scanning along one or more of these axes may be used to direct thefocal point of the pulsed laser beam 18 into the intraocular lens 30.

The controller 22 can access an updateable database of scanning routinesto modify the subsurface region(s) of the intraocular lens 30. In oneembodiment, each of the scanning routines corresponds to a particulartype of intraocular lens and provides a selection of pre-programmedscanning instructions to affect a variety of modifications. For example,for a specific intraocular lens type, a scanning routine accounts forthe lens dimensions, material properties, surface shapes, and the like,associated with the lens. The scanning instruction can includepre-identified subsurface locations within the particular intraocularlens, or sets of locations, that correspond with increasing/decreasingflexibility of a support element (e.g., a hinge or a haptic),increasing/decreasing viscoelasticity of a portion of the intraocularlens, creating one or more slip zones at pre-determined subsurfaceregions, or altering a variety of other mechanical or structuralproperties of a desired portion of the intraocular lens. Each of thepre-programmed scanning instructions can be manually modified via theuser interface 32 as well, such as for customization.

For example, in one embodiment, an image of the eye illustrating thelocations of various anatomical structures of the eye as well theintraocular lens 30 location can be displayed on a touch-sensitivescreen of the user interface 32. For a particular intraocular lens typeand desired modification, the user interface 32 displays the locationsof the subsurface regions to be scanned by the pulsed laser beam 18. Theoperator can modify the locations of the subsurface regions using aninput device, such as a stylus, and drawing on the touch-sensitivescreen a change from the illustrated subsurface regions to a modifiedsubsurface location. In another embodiment, the operator indicates thedesired subsurface regions on the touch-sensitive screen, and thecontroller 22 determines a corresponding scanning procedure fordirecting the pulsed laser beam 18 at the subsurface regions.

In another embodiment, the operator can indicate a desired mechanicalmovement of a portion of the intraocular lens on the touch-sensitivescreen (e.g., via a drawn arrow on the touch-sensitive screen indicatinga displacement along the direction of the arrow). An image recognitionapplication may be used by the controller 22 to identify the desiredmechanical movement from the drawn arrow, and the controller 22 can thendetermine and propose subsurface regions (e.g., displayed on the userinterface 32) to be scanned corresponding to the desired mechanicalmovement. For example, the operator can indicate a desired shift inposition (e.g., a shift along the x- and/or y-axis, a shift along thez-axis, a tilt, a rotation, and the like) of the optic or intraocularlens as a whole (e.g., to establish the proper power provided by theintraocular lens, fine tune the refractive correction, and the like).One or more slip zones can also be drawn or otherwise indicated by theoperator on the user interface 32 (e.g., via the touch-sensitivescreen), and the controller 22 then determines the scanning procedure toproduce the slip zones.

For further customization, the system 10 acquires detailed informationabout optical aberrations to be corrected, at least in part, using thesystem 10. These aberrations are determined prior to implantation of theintraocular lens 30, at a time subsequent to the implantation of theintraocular lens 30 (e.g., after the settling period followingimplantation), after further ophthalmic procedures (e.g., LASIK or othercorneal corrections, intracorneal modifications such as intracornealimplants, and the like) have been performed, or concurrently with theprocedure for modifying the intraocular lens 30. Examples of suchdetailed information include, but are not necessarily limited to, thedesired correction, the actual correction (e.g., measured), there-orientation of the intraocular lens, and the like.

The refractive power of the cornea with or without corrections madethereto (e.g., prior ophthalmic procedures such as flap creation, LASIK,photorefractive keratectomy (PRK), laser assisted sub-epitheliumkeratomileusis (LASEK), corneal pocket creation, corneal transplant, andthe like) may be used to determine initial refractive corrections and/oradditional corrections. Wavefront analysis techniques, made possible bydevices such as a Hartmann-Shack type sensor (not shown), can be used togenerate maps of corneal refractive power. Other wavefront analysistechniques and sensors may also be used. The maps of corneal refractivepower, or similar refractive power information provided by other means,such as corneal topographers, optical coherence tomography scanners,pachymeters, and the like, can then be used to identify and locateoptical aberrations of the cornea that require correction. Determinationof the particular subsurface regions within the intraocular lens foralteration (e.g., mechanical or structural alteration via the pulsedlaser beam 18) can be based on the refractive power map or other opticalmodeling of the patient's eye. In one embodiment, real-time wavefrontanalysis is used as a feedback mechanism for guiding the intraocularlens modifications. This wavefront analysis may be concurrentlydisplayed on the user interface 32 or as a separate image together withthe image of the eye and intraocular lens to substantially indicate theeffects of the modifications in real-time (e.g., the wavefront analysisrepresents in real-time the optical effects associated with theintraocular lens modifications, re-orientations, and the like).

FIG. 2 is a block diagram of an ophthalmic laser system 40 in accordancewith one embodiment of the present invention. Referring to FIGS. 1 and2, the ophthalmic laser system 40 includes, but is not necessarilylimited to, a laser source 42 providing a pulsed laser beam (e.g., thepulsed laser beam 18), a beam monitoring and processing module 44, abeam delivery module 46 coupled to the beam monitoring and processingmodule 44, the user interface 32, and the imaging system 34. Althoughdescribed as a single system, one or more components of the system 40may be self-contained separate subsystems that are coupled together toform the system 34. The pulsed laser beam is supplied to the beammonitoring and processing module 44 where the pulse energy, the focalpoint separation, and optionally the minimum sub-surface depth of thepulsed laser beam are controlled. For example, a beam splitter (notshown), such as the beam splitter 26, can be used to provide a feedbackloop for the pulsed laser beam 18 to the beam monitoring and processingmodule 44. The beam delivery module 46 scans the pulsed laser beam alonga desired scan region (e.g., as determined by the controller 22). Inthis embodiment, the ophthalmic laser system 40 can be coupled to theeye 11 via a patient interface 33, and the patient interface 33 may becoupled to the ophthalmic laser system 40 at a moveable loading deck 35,for example. The configuration of the ophthalmic laser system 40 mayvary as well as the organization of the various components and/orsub-components of the ophthalmic laser system 40. For example, somecomponents of the beam delivery module 46 are incorporated with the beammonitoring and processing module 44 and vice versa.

The user interface 32 is coupled to the beam delivery module 45, and avariety of system parameters may be input or modified by the operatorvia the user interface 32 to control the beam properties and thusproduce the desired photoalteration. For example, the user interface 32includes a display presenting a graphical user interface with thevarious system parameters and an input device (not shown) for selectingor modifying one or more of these parameters. The number and type ofsystem parameters may vary for modifying a particular intraocular lens(e.g., pulse energy, spot size, spot shape, focal point separation,focal point depth, scanning pattern, scanning sequence, scan rate, andthe like). While described for modifying intraocular lenses, the system40 may be used for a variety of other ophthalmic procedures (e.g., flapcreation, PRK, LASIK, LASEK, corneal pocket creation, cornealtransplant, corneal implant, corneal inlay, and the like), andadditional system parameters may be provided by the user interface 32for such other procedures.

In one embodiment, the parameters are input, selected, or modified bythe operator via the user interface 32. For intraocular lensmodification, the operator is prompted via the user interface 32 withthe selection of parameters. The parameters may be displayed as defaultvalues for selective modification by the operator. Additional parametersmay also be displayed by the user interface 32 for different proceduresusing the system 40.

In response to the system parameters selected or input via the userinterface 32, the beam monitoring and processing module 44 and/or thebeam delivery module 46 produce a pulsed laser beam with propertiescorresponding with the system parameters. In one embodiment, the beammonitoring and processing module 44 includes, but is not necessarilylimited to, an energy attenuator 41, one or more energy monitors 43, andan active beam positioning mirror 45. The pulsed laser beam is directedfrom the laser source 42 to the energy attenuator 41, then to the energymonitor 43, and then to the active beam positioning mirror 45. Theactive beam positioning mirror 45 directs the pulsed laser beam from thebeam monitoring and processing module 44 to the beam delivery module 46.Using the energy attenuator 41 and energy monitor 43, the pulse energyof the pulsed laser beam may be varied to desired values. Additionally,the spatial separation of the focal points of the pulsed laser beam maybe varied by the beam monitoring and processing module 44. This isparticularly useful to increase the precision associated with a desiredmodification of the intraocular lens 30 (e.g., to create a slip zonewithin the intraocular lens with pre-determined dimensions correspondingto a desired displacement or actuation).

The beam delivery module 46 scans the pulsed laser beam at the desiredsubsurface region of the intraocular lens 30. In one embodiment, thebeam delivery module 46 includes, but is not necessarily limited to, abeam position monitor 47, an x-y scanner 49, a beam expander 52, one ormore beam splitters 54, and a z-scanning objective 56. The pulsed laserbeam is received from the beam monitoring and processing module 44 bythe x-y scanner 49 and directed to the beam expander 52, and the beamexpander 52 directs the pulsed laser beam to the z-scanning objectivevia the beam splitter(s) 54. The z-scanning objective 56 can vary thefocal point depth of the pulsed laser beam (e.g., from the anteriorsurface of the eye 12 or cornea to any depth within the eye 31 up to andincluding the retinal region). For modifying the intraocular lens 30,the z-scanning objective 56 preferably directs the focal point of thepulsed laser beam to the depth of the intraocular lens 30 within thelens capsule bag.

Prior to initiating scanning or otherwise initiating photoalteration ofthe intraocular lens 30, the eye 12 is preferably substantiallyimmobilized with respect to the ophthalmic laser system 40 (e.g., theophthalmic laser system 40 can be coupled to the eye 12). In oneembodiment, the patient interface 33 provides a surface for contactingthe cornea of the patient's eye 12, which may also be used to applanatethe cornea. A suction ring assembly 53 or other device may be applied tothe eye 12 to fixate the eye prior to coupling the ophthalmic lasersystem 40 to the eye (e.g., via the patient interface 33). In oneembodiment, the suction ring assembly 53 has an opening providing accessto the eye 12 when coupled thereto. The imaging system 34 may be used tofacilitate the coupling of the ophthalmic laser system 40 with the eye12. For example, by providing a real-time image of the fixated eye, theoperator can view the eye to properly center the output of the beamdelivery module 46 (e.g., with respect to the pupil, the iris, the pupiland the iris, any other features of the eye 12, the intraocular lens 30,or any structure of the intraocular lens 30).

Once the ophthalmic laser system 40 is coupled to the eye 12, theimaging system 34 may be used for alignment or centration of the laseroutput (e.g., the beam delivery module 46 output) and/or applanation ofthe cornea using the patient interface 33. A variety of centration andalignment devices or methods (e.g., two-dimension alignment, such as x-and y-axis, or three-dimension alignment, such as x-, y-, and z-axis)may also be used with the imaging system 34 to couple the system 40 withthe eye 12. The imaging system 34 preferably provides a real-time,magnified, high resolution digital image of the eye 12 and includes, butis not necessarily limited to, an image sensor 57, an imaging interface59, and an image processor 58 coupled to the sensor 57 and the interface59. An image of the eye 12, as well as the intraocular lens 30, iscaptured using the image sensor 57 and displayed by the imaginginterface 59. In one embodiment, a high resolution digital camera (e.g.,a high-definition digital video camera based on charge coupled devices(CCDs) or the like) is used to capture the image and display the imageon the imaging interface 59.

Although FIG. 2 illustrates a combination of the image sensor 57 andbeam splitters 54 for capturing the image, the image sensor 57 may belocated in a variety of different positions or operate solely or operatewith additional optical elements to directly or indirectly captureimages of the eye 12. For example, the image sensor 57 may be locatedsubstantially adjacent to the z-scanning objective 56 to directlycapture images of the eye 12. In one embodiment, the image sensor 57 ismounted on a moveable gantry to vary the image focal plane captured bythe image sensor 57 and optically coupled with a variable aperture (notshown) (e.g., positioned between the image sensor 57 and the eye 12) forcontrolling the depth of focus and/or the amount of light sensed by theimage sensor 57. In another embodiment, at least one or more of a focuscontrol for varying the image focal plane captured by the image sensor57 and a focus depth control are incorporated into the image sensor 57.This is useful for focusing onto an optical plane associated with theintraocular lens 30, particularly in instances when greater resolutionis desired than associated with the depth of focus.

The imaging interface 59 includes, but is not necessarily limited to, aninput device for operator selection of the system parameters (e.g.,associated with coupling the ophthalmic laser system 40 with the eye 12,modification of the desired subsurface regions of the intraocular lens30, image control, and the like) and a monitor displaying the real-time,magnified, high resolution digital image of the eye 12, variousstructures of the eye 12, the intraocular lens 30 implanted within theeye 12, and the like. The input device includes one or more of akeyboard, a trackball, a mouse, a touch-pad, a touch-sensitive screen, ajoystick, a variable focal length switch, a footswitch, and the like. Ina preferred embodiment, the imaging interface 59 includes atouch-sensitive screen displaying a graphical user interface forselecting the system parameters and for viewing the eye 12, theintraocular lens 30, the alignment or centration of the laser outputwith reference to the eye 12, pre-determined or selected subsurfaceregions of the intraocular lens, and the like. The graphical userinterface provides a variety of buttons, icons, or the likecorresponding with different functions for selection by the operator,and the operator selects a particular function by touching thecorresponding button displayed on the touch-sensitive screen.

Operator control of the beam delivery module 46 alignment with the eye12 or intraocular lens 30, applanation of the cornea, and/or centrationis provided via the input device of the imaging interface 59 or via aseparate input device (e.g., a joystick). For example, the operatorcontrols the raising, lowering, or lateral movement (two-dimensions) ofthe loading deck 35 with the joystick while viewing the digital image ofthe eye 12 provided by the imaging system 34. The operator can adjustthe lateral position (e.g., an x-axis position and a y-axis position) ofthe loading deck 35 to align the output of the beam delivery module 46with the eye 12 and lower the loading deck 35 (e.g., along a z-axis) toguide the patient interface 33 into a pre-determined position with thesuction ring 53 (e.g., coupling the beam delivery module 46 with the eye12). An indicator may also be displayed by the imaging interface 59(e.g., a green light) when the beam delivery module 46 is properlycoupled with the eye 12 or when an applanation surface of the patientinterface 33 contacts the cornea. The operator then applanates thecornea by further lowering the beam delivery module 46 (e.g., theloading deck 35 and patient interface 33) using the input device, whilemonitoring the degree of applanation as indicated by the digital imageof the eye 12, and discontinuing movement of the beam delivery module 46at a desired degree of applanation determined by viewing the digitalimage of the eye 12.

In one embodiment, a centration aid is displayed as an overlay on thedigital image of the eye 12 for assisting in centering the laser outputwith the eye 12 or the intraocular lens 30. The centration aidcorresponds with the current position of the laser output with referenceto the eye 12 or the intraocular lens 30 (e.g., the two-dimensionalposition in the focal plane of the pulsed laser beam and/or axialalignment of the pulsed laser beam with reference to an optical axis ofthe eye 12 or intraocular lens 30). The operator can align or center thelaser output using the joystick, or other input device, together withthe centration aid. For example, by centering the centration aid withreference to the image of the pupil, the iris, the intraocular lens 30,or any combination thereof, displayed by the imaging interface 59, theoutput of the beam delivery module 46 becomes centered with reference tothe pupil, the iris, both the pupil and iris, the optic of theintraocular lens, or any structure of the intraocular lens or the eye.Following alignment or centration, the operator can initiate scanningand photoalteration of the desired subsurface region(s) of theintraocular lens (e.g., within the haptic, the optic, or both the hapticand optic).

FIG. 3 is a cross-sectional view of the human eye 12 with the implantedintraocular lens 30, shown in FIG. 1. Light enters from the left of FIG.3, and passes through the cornea 62, the anterior chamber 63, the iris64, and enters the capsular bag 65. The intraocular lens 30 replaces thenatural lens of the eye 12. Prior to surgery, the natural lens occupiesessentially the entire interior of the capsular bag 65. After surgery,the capsular bag 65 contains the entire intraocular lens 30, in additionto a fluid (not shown) that occupies the remaining volume (e.g.,unoccupied by the intraocular lens 30) and equalizes the pressure withinthe eye 60. After passing through the intraocular lens 30, light exits aposterior wall 66 of the capsular bag 65, passes through a posteriorchamber 67, and strikes the retina 68, which detects and converts thelight to a signal transmitted through the optic nerve to the brain.

The intraocular lens 30 has an optic 69 with a refractive index greaterthan the fluid surrounding the intraocular lens 30. The optic 69 has ananterior surface 70 facing away from the retina 68 and a posteriorsurface 71 facing toward the retina 68. The optic 69 is held in place bya positioning member 72 (e.g., a haptic), which couples the optic 69 tothe capsular bag 65. In this embodiment, the optic 69 is suspendedwithin the capsular bag 65 to allow accommodative movement of the optic69 of the intraocular lens 30 along the optical axis, for example. Inanother embodiment, the intraocular lens 30 is disposed adjacent to, andeven pressed against, the posterior wall 66, for example, to reducecellular growth on the optic 69. The optic 69 can also be a monofocalintraocular lens or a multifocal intraocular lens.

A well-corrected eye typically forms an image at the retina 68. If thelens has too much or too little power, the image generally shiftsaxially along the optical axis away from the retina 68 and toward oraway from the lens. Note that the power associated with focusing on aclose or near object is more than the power associated with focusing ona distant or far object. The difference in optical power between thefarthest and nearest object that may be brought into focus by aparticular lens or lens system is commonly referred to as an “add power”(e.g., in the case of a multifocal intraocular lens) or a “range ofaccommodation” or “accommodative range” (e.g., in the case of anaccommodating intraocular lens that responds to ciliary musclecontraction to move and/or deform axially and thereby change the opticalpower of the corresponding optic). A normal add power or accommodationis about four (4) Diopters at the plane of the optic 69 of anintraocular lens, although this number may be three (3) or fewerDiopters or six (6) or more Diopters, depending on the geometry of theparticular eye.

An accommodating intraocular lens, such as those disclosed in U.S.Patent Application Publication Number 2004/0111153 (Woods et al.), or inU.S. Pat. No. 7,713,299 (Brady et al.) and U.S. Patent ApplicationPublication Number 2008/0161914 (Brady et al.), all of which are hereinincorporated by reference in their entirety, may be used as theintraocular lens 30. For example, the optic 69 has a clear aperture thatis disposed about a central axis or optical axis (OA). The optic isconfigured to change shape in response to an ocular force, therebychanging the optical power of the optic by at least about one (1)Diopter, preferably by at least two (2) Diopters, three (3) Diopters, orfour (4) Diopters. For example, the optic may be made of a relativelysoft material such as a soft acrylic or silicone material having amodulus of less than about 100 kPa or less than about 50 kPa. As usedherein, the term “ocular force” refers to a force produced by the eyefor accommodation, for example, a force produced by the ciliary muscle,zonules, or capsular bag of the eye. Alternatively or additionally, theoptic 69 may be configured to produce an effective change in the opticalpower of the optic by displacing the optic along the optical axis OA inresponse to an ocular force. The positioning member 72 is generallyflexible and configured for changing the shape of the optic 69 inresponse to the ocular force.

The intraocular lens 30 is generally configured to be placed within thecapsular bag of the eye and configured to be compressed to provide nearor intermediate vision and/or stretched to provide distant vision. Inanother embodiment, the optic 69 may further include a mask (not shown)having a mask profile that is imposed on, added to, or combined with theshape of a base surface of the optic. The mask includes a diffractive orrefractive surface with a relatively low add power in anotherembodiment. For example, a low add power of less than about two (2)Diopters, or even less than one (1) Diopter, may be used to increase thedepth of focus of the intraocular lens when in one or more states ofaccommodation, thereby reducing the amount of deformation ordisplacement necessary to provide a predetermined amount ofaccommodation. In another embodiment, the diffractive surface isreplaced with or added to a surface profile incorporating one or more ofthe other configurations discussed herein to provide extended orenhanced depth of focus.

The ocular force applied to the intraocular lens 30 is generallyprovided directly by the capsular bag into which the intraocular lens isplaced. In another embodiment, the positioning member 72 is configuredso that the ocular force used to deform the optic 69 is provided moredirectly by the ciliary muscle and/or zonules, for example, by removingthe capsular bag or placing the intraocular lens in front of thecapsular bag. In any case, the intraocular lens 30 is generallyconfigured to provide a predetermined amount of accommodation when theciliary muscle contracts and/or relaxes and with an ocular force of lessthan about twenty (20) grams, less than about ten (10) grams, or evenless than about five (5) grams.

The intraocular lens 30 is configured to have a predetermined ocularpower when in a reference state, for example, with substantially noexternal forces on the intraocular lens 30, except for gravity. In someembodiments, while there is substantially no external force on theintraocular lens 30 when in the reference state, the intraocular lensexperiences internal forces, for example, produced between the optic 69and the positioning member 72 due to a pre-stress introduced duringfabrication. The optical power of the intraocular lens 30, when in thereference state, is selected to provide near vision (an accommodativebias), distant vision (a dis-accommodative bias), or intermediatevision.

The positioning member 72 may also be configured to additionallytranslate the intraocular lens 30 along the optical axis in the anteriordirection (e.g., toward the cornea) to further enhance the accommodativepower of the intraocular lens 30. In other embodiments, the positioningmember 72 is replaced by a positioning member particularly suited forproviding accommodative motion along the optical axis OA, for example, apositioning member configured like or similar to those disclosed in U.S.Patent Application Numbers 2004/0082993, 2004/0111153, or 2006/0253196,all of which are herein incorporated by reference.

A diffractive or refractive multifocal lens may also be used for theintraocular lens 30. For example, the optic 69 can have an anteriorsurface with a first shape, an opposing posterior surface with a secondshape, and a multifocal element or pattern imposed on, added to, orcombined with the second shape. The first and second surfaces togetherproviding a base power and an add power, and the add power generallyresults from an add power associated with the multifocal element. Incertain embodiments, the add power or effective add power of the optic69 is produced by a combined effect of both the anterior and posteriorsurfaces. For example, a mask with an add power can be combined with anadd power of the multifocal element to produce a total or effective addpower of the optic 69. Alternatively, the profile of the maskdifferently affects a base power and an add power of the multifocalelement to produce an add power of the optic 410 that is higher or lowerthan the power of the multifocal element alone.

In one multifocal embodiment, the anterior and posterior surfaces areconfigured to produce a first focus and a second focus when the optic 69is placed within the eye. The first focus corresponds to or is producedby the base power of the optic 69 and generally provides a subject withdistant vision. The second focus corresponds or is produced by the addpower of the optic 69 and generally provides a subject with near orintermediate vision. As used herein, the term “near vision” refers tofocusing on objects or planes that are relatively close to the subject,generally within a range of about 25-40 cm or at a distance at which asubject would generally place printed material for the purpose ofreading. As used herein the term “intermediate vision” refers tofocusing on objects situated approximately 40 centimeters toapproximately 1.5 meters from the eye or a spectacle plane. As usedherein, the term “distant vision” refers to focusing on objects orplanes that are relatively distant from the subject, for example,generally at a distance that is greater than about 1 meter to about 2meters away from the subject or at a distance of 5 to 6 meters orgreater.

The base power and the add power are generally powers of the optic whenthe lens is disposed within a medium having a refractive index similarto that of the aqueous humor of the eye, for example, in a medium havinga refractive index of or about 1.336. In other embodiments, thereference media is different from the media of the aqueous humor, forexample, a refractive index of air or about 1.

The multifocal element can be a diffractive element in which two or morediffractive orders are used to provide two or more optical powers.Alternatively or additionally, the multifocal element is a refractivemultifocal, for example, as disclosed in U.S. Pat. No. 5,225,858 or U.S.Pat. No. 6,210,005, which are incorporated in their entirety herein. Insome embodiments, the multifocal element has a relatively low add power(e.g., less than about or equal to 2 Diopters or less than or equal toabout 1 Diopter), for example, with a diffractive pattern. In suchembodiments, the relatively low add power of the multifocal element canbe combined with a multifocal element on the anterior surface to producea combined add power of the optic that has a predetermined value. Inother embodiments, the multifocal element has a relatively high addpower (e.g., greater than or equal to about 3 Diopters or greater thanor equal to about 4 Diopters), for example, so that the intraocular lensprovides two or more distinct foci when placed in the eye of a subject(e.g., to one for near vision and another for distant vision).

The system 10, 40 may be used to modify the structure of the intraocularlens 30 following implantation/insertion into the eye. In oneembodiment, material from the intraocular lens 30, such as on or in thepositioning member 72, is ablated or photoaltered (e.g., by the pulsedlaser beam produced by the system 10, 40). For example, void areaswithin the positioning member 72 are produced to weakened specific zoneswithin the positioning member 72. In general, the pulsed laser beamproduced by the system 10, 40 (e.g., using a laser with an ultra-shortpulse in the picosecond to femtosecond range, such as an Nd:YLF laseroperating at a wavelength of about 1053 nm) does not produce heatsufficient to impair the eye. The system 10, 40 may thus be focused toproduce a condition of laser-induced optical breakdown, which producesan insignificant amount of heat.

In one embodiment, an accommodating intraocular lens has an optic and apositioning member or support structure with multiple arms, and each ofthe arms has a hinge area about which the arm can pivot and provideaccommodative motion of the optic. For implantation/insertion (e.g.,through a relatively narrow conduit), the hinges may be configured withsubstantial stiffness to withstand transportation through the narrowconduit. For example, the hinges are formed of a material having adesired stiffness or relative inflexibility. Followingimplantation/insertion, the hinges are biomechanically altered by thesystem 10, 40 to allow a more efficient transfer of ocular forces (e.g.,from the ciliary muscle) into axial motion of the optic. In one example,the system 10, 40 precisely directs the pulsed laser beam at the hingesto create sub-surface slip zones, which enhance the accommodative effectof the intraocular lens.

In another embodiment, the accommodating intraocular lens is implantedinto the eye and includes a haptic of photosensitive polymer materialthat is partially polymerized. The partially polymerized haptic is morecompliant for transport through the narrow conduit. Followingimplantation/insertion, the system 10, 40 can be used to direct thepulsed laser beam into the haptic to extend polymerization of the hapticuntil a pre-determined stiffness is achieved (e.g., a stiffness suitedto the transfer of energy to the intraocular lens for accommodativemotion and/or deformation of the optic).

In yet another embodiment, the intraocular lens includes an optic and asupport structure that are separately implanted into the eye.Alternatively, the optic and support structure are partially coupled toone another for a more compact configuration of the intraocular lensduring implantation/insertion into the eye. Followingimplantation/insertion of both structures, the system 10, 40 can directthe pulsed laser beam to join or weld portions of the optic to thesupport structure.

The pulsed laser beam produced by the system 10, 40 may also be used tofit the implanted intraocular lens 30 to the capsular bag 65 or otherstructure. For example, the support structure can be weakened, expanded,or rearranged to fit the intraocular lens to the capsular bag. This isparticularly useful for enhancing or optimizing an accommodative effectof a suitably configured intraocular lens.

As previously mentioned, a variety of re-orientations (e.g.,displacements horizontally, vertically, diagonally, rotationally,non-linearly, combinations of one or more of the foregoing, and thelike) are possible using the system 10, 40. FIG. 4 is a top sectionalview of an implanted intraocular lens 80 illustrating a re-orientationin accordance with one embodiment. FIG. 5 is a top sectional view of theimplanted intraocular lens 80 illustrating a re-orientation inaccordance with another embodiment. FIG. 6 is a side sectional view ofthe implanted intraocular lens 80 illustrating a re-orientation inaccordance with another embodiment. The intraocular lens 80 is implantedwithin the capsular bag 82 of an eye, such as the eye 12 shown in FIGS.1 and 2. In these embodiments, the intraocular lens 80 is re-orientedfrom an initial position (in broken line) to the final positionillustrated in FIGS. 4-6. The final position is substantially aligned(e.g., centered) with reference to an optical axis, A, of the eye. Thesystem 10, 40 (FIGS. 1 and 2) may be used for these re-orientations aswell as for a variety of other re-orientations of an in situ intraocularlens. As shown in FIG. 4, the intraocular lens 80 is translated alongthe horizontal axis or a y-axis to center the intraocular lens 80 aboutthe optical axis or another selected axis. As shown in FIG. 5, theintraocular lens 80 is rotationally re-oriented about the optical axis.As shown in FIG. 6, the intraocular lens 80 is re-oriented along theoptical axis or a z-axis to vault the intraocular lens 80 against theposterior portion 84 of the capsular bag 82.

Although the final position of the intraocular lens 80 is substantiallyaligned with reference to the optical axis, the intraocular lens 80 maybe aligned based on other references, including the pupil or macula, forexample. Using real-time wavefront analysis or other refractive analysistechniques of the eye for feedback input, the system 10, 40 can alsoindicate (e.g., via the user interface 32 shown in FIG. 1) the relativechange to the refractive profile of the eye during re-orientation aswell as subsequent to re-orientation of the intraocular lens 80.

FIG. 7 is a sectional view of the intraocular lens 80 illustrating slipzones 90, 92 in accordance with one embodiment. The intraocular lens 80includes an optic portion 86 and a haptic portion 88, and the slip zones90, 92 are located in pre-determined sub-surface regions of theintraocular lens 80 to induce a modification to the mechanical orstructural characteristics thereof. The system 10, 40 (FIGS. 1 and 2,respectively) may be used to form the slip zones 90, 92. In thisembodiment, some slip zones 92 are formed in the haptic portion 88 or ina hinge coupling the haptic portion 88 to the optic portion 86, and someslip zones 90 are formed in the optic portion 86. With the slip zones92, the flexibility of the haptic portion 88 as a whole may betemporarily or permanently altered, and this feature can facilitate are-orientation of the intraocular lens 80. For example, the slip zones92 can increase flexibility of the haptic portion 88 to allowdisplacement of the position of the optic portion 86 (e.g., anterior orposterior vaulting, rotation, tilt, linear shift, and the like) and tomore precisely or more accurately implement the refractive correctionprovided by the intraocular lens 80. The intraocular lens 80 may also beengineered with various structural elements that have beenpre-determined to facilitate a desired re-orientation (e.g., along aspecific displacement vector). In another example, the slip zones 92 areformed prior to implantation (e.g., during manufacture or finishing ofthe intraocular lens 80) to increase flexibility of the haptic portion88 and ease folding or insertion of the intraocular lens 80.

The slip zones 90 formed in the optic portion 86 may also assist inre-orienting the intraocular lens 80. Alternatively, the slip zones 90can impart or diminish mechanical or structural properties associatedwith the optic portion 86. For example, some degree of accommodation canbe provided to the optic portion 86 by the slip zones 90 as one portionof a slip zone displaces with respect to the other portion (e.g., aslide motion). The location of the slip zones 90, 92 may bepre-determined based on known properties of the intraocular lens 80, therefractive profile of the eye, and the like, displayed as defaults,altered and/or indicated by the operator, such via a user interface.

FIG. 8 is a front view of a user interface 94 illustrating anintraocular lens re-orientation in accordance with one embodiment. Theuser interface 94 has a touch-sensitive screen 95 displaying a real-timeimage of an implanted intraocular lens 96 and provides a variety ofsystem controls (e.g., selectable touch-sensitive buttons). Otherrepresentations of the implanted intraocular lens 96 may be displayed bythe user interface 94 (e.g., based on real-time wavefront analysis,historical data of the patient's eye, and the like). The intraocularlens 96 is implanted in the capsular bag 98 of a patient's eye. In thisembodiment, the operator has indicated a desired re-orientation of theintraocular lens 96 via a directional symbol 99 (e.g., an arrow). Forexample, the operator can use a stylus to draw the directional symbol 99on the user interface 94. The placement of the directional symbol 99 aswell as other characteristics of the directional symbol 99 (e.g., thelength, shape, and the like) is detected by an image recognitionapplication, and proposed modifications to the intraocular lens 96 canbe determined and displayed by the user interface 94 to the operator.

The user interface 94 includes a “Back” button configured to return thedisplayed menu of system controls to a prior displayed menu, an“Auto-position” button configured to indicate a pre-determinedre-orientation of the intraocular lens 96 on the displayed image (e.g.,as an overlay image), a “Linear Shift” button configured to interpretthe directional symbol 99 as a linear displacement, a “Rotate” buttonconfigured to interpret the directional symbol 99 as a rotationaldisplacement, a “Manual” button configured to indicate a directcorrelation of the directional symbol 99 with the desired displacement,a “Depth+” button configured to increase the focal plane depth of thedisplayed image, a “Depth−” button configured to decrease the focalplane depth of the displayed image, a “View Adjust” button configured torecall a menu of different views corresponding to the displayed image, a“Magnify” slide button configured to vary the displayed imagemagnification, and a “Fine/Coarse” slide button configured to vary themagnitude of displacement indicated by the directional symbol 99. Avariety of other functions or combinations of some of the foregoingsystem controls may be provided by the user interface 94 via one or moreof the same or different input mechanisms.

Additionally, the user interface displays a centration aid 93 as anoverlay image, which may assist in determining the re-orientation of theintraocular lens 96 (e.g., with respect to a pre-determined reference).Following the selection or indication of the desired re-orientation, asuitable scan pattern is determined to direct the pulsed laser beam atthe corresponding sub-surface regions of the intraocular lens 96.

FIG. 9 is a flow diagram of a method 100 for modifying a refractiveprofile of an eye having an intraocular device implanted therein inaccordance with one embodiment. A corrected refractive profile isdetermined based on an initial refractive profile of an eye, asindicated at 105. Referring to FIGS. 1 and 2, for example, the initialor starting refractive profile of the eye 12 can be determined usingwavefront analysis techniques prior to modification of the intraocularlens 30. In one embodiment, the intraocular lens 30 is determined to bein an initial position within the eye 12. A corrected position of theintraocular lens 30 can be determined (e.g., by modeling in situmechanical behavior of the intraocular lens 30 using known mechanical orstructural characteristics of the intraocular lens 30, real-time orhistorical wavefront analysis of the eye 12 with the implantedintraocular lens 30, and the like) based on a re-orientation of theintraocular lens 30 to produce the corrected refractive profile.

One or more locations within the intraocular device are identified basedon the corrected refractive profile, as indicated at 110. For example,the controller 22 determines which sub-surface regions of theintraocular lens 30 (e.g., within one or more haptics or supportelements, within the optic, or within both) are to be irradiated withthe pulsed laser beam 18 to produce the corresponding re-orientation ofthe intraocular lens 30 (resulting in the corrected refractive profile).The locations within the intraocular device may also be determined bythe operator or through a combination of controller 22 and operatorinput.

A pulsed laser beam is directed at the one or more locations within theintraocular device to produce the corrected refractive profile, asindicated at 115. In one embodiment, the intraocular device is displacedfrom the initial position within the eye (e.g., pre-modification) to acorrected position within the eye based on directing the femtosecondlaser beam at the one or more locations. Referring to FIGS. 4-6,examples are shown of displacing the intraocular lens 80 from theinitial position (shown in broken line) to the corrected position. Thecorrected position of the intraocular device within the eye at leastpartially implements the corrected refractive profile.

The pulsed laser beam 18 may have a pre-determined pulse energy lessthan or equal to about 800 nanojoules/pulse, a pre-determined pulsewidth between about 300 picoseconds and about 10 femtoseconds, and/or apre-determined wavelength between about 400 nm to about 3000 nm.Typically, the intraocular lens 30 is located within the capsular bag(e.g., following implantation/insertion and prior to modification). Theintraocular device 30, or portions thereof, may have a pre-determinedthermal threshold (e.g., a glass transition temperature) or apre-determined viscoelasticity. In one example, the pulsed laser beam 18is directed into the capsular bag and into the intraocular lens 30 atthe sub-surface regions (e.g., by scanning) to heat these sub-surfaceregions above the thermal threshold. The mechanical or structuralcharacteristic of the intraocular lens 30 is thus modified by suchheating, and the intraocular lens 30 may then be re-oriented within theeye 12 (e.g., horizontally displaced, vertically displaced, displacedtowards the cornea, displaced towards the retina, rotated, tilted, andthe like, or any combination thereof). In another example, referring toFIG. 7, one or more slip zones 90, 92 may be formed at the sub-surfaceregions via the pulsed laser beam 18 to re-orient the intraocular lens30 to the corrected position. The slip zones 90, 92 allow weakening,expansion, or rearrangement of the intraocular lens 30 to fit to thecapsular bag, for example. This is particularly useful for enhancing oroptimizing an accommodative effect of a suitably configured intraocularlens.

In addition to modifying or re-orienting in situ intraocular lenses,FIG. 10 is a flow diagram of a method 200 for modifying a refractiveprofile associated with an eye in accordance with another embodiment. Anoptic is implanted within the eye, as indicated at 205. A supportelement (e.g., a haptic) is implanted within the eye, as indicated at210. A pulsed laser beam is directed into the support element and theoptic to fuse the support element to the optic, as indicated at 215. Theresulting intraocular device within the eye (i.e., with the supportelement fused to the optic) modifies the refractive profile of the eye.In one embodiment, the support element may be partially coupled to theoptic and implanted in this arrangement (e.g., to ease the insertion orimplantation process). The intraocular lens may then be assembled insitu by fusing the support element to the optic. The pulsed laser beammay also fix the support element to the optic by other techniques, suchas initializing polymerization and the like.

Thus, the systems 10, 40 can precisely modify and/or re-orient in situintraocular lenses while minimizing particulate generation during thisprocess. While embodiments of this invention have been shown anddescribed, it will be apparent to those skilled in the art that manymore modifications are possible without departing from the inventiveconcepts herein.

1. A method of modifying a refractive profile of an eye, the eye havingan intraocular device implanted therein located at an initial positionwithin the eye and the eye having an initial refractive profile, themethod comprising the steps of: determining a corrected refractiveprofile for the eye based on the initial refractive profile; identifyingone or more locations within the intraocular device based on thecorrected refractive profile; and directing a pulsed laser beam at theone or more locations to re-orient the intraocular device to a correctedposition within the eye and produce the corrected refractive profile. 2.The method of claim 1, wherein the intraocular device is re-oriented inresponse to the directed pulsed laser beam by at least one of the groupconsisting of a horizontal displacement, a vertical displacement, arotation, a tilt, a displacement towards a cornea of the eye, and adisplacement toward a retina of the eye.
 3. The method of claim 1,wherein the intraocular device has a thermal threshold, and wherein thedirecting step further comprises heating the one or more locations abovethe thermal threshold via the pulsed laser beam, the intraocular devicere-orienting from the initial position to the corrected position withinthe eye based on the heating.
 4. The method of claim 1, wherein theintraocular device has a viscoelasticity, and wherein the directing stepfurther comprises modifying the viscoelasticity via the pulsed laserbeam, the intraocular device re-orienting from the initial position tothe corrected position within the eye partly based on the modifying.5.-17. (canceled)
 18. A method of modifying a refractive profileassociated with an eye via an intraocular device, the intraocular devicecomprising an optic and a support element, the method comprising thesteps of: implanting the optic within the eye; implanting the supportelement within the eye; and directing a pulsed laser beam into both ofthe support element and the optic to fuse the support element to theoptic, the intraocular device within the eye configured to modify therefractive profile.
 19. The method of claim 18, wherein the supportelement is partially coupled to the optic.